Growing integrated healthcare provider seeks a National Medical Director to lead the company’s utilization management clinical team. This is a remote role with associated travel, so candidates can live in any US city with easy access to major airport.
typical roles and responsibilities for National Medical Director – UM
- Oversee utilization management team activities including reviewing requests and making coverage determinations for services and supplies for delegated lines of business.
- Act in a leadership role as medical manager and policy advisor to the company and clients.
- Executes the Utilization/Cost Management Programs and relevant Clinical Quality Improvement Programs in partnership with the company leadership
- Interfaces with provider community on Utilization Management and evidence-based medicine
- Provides education to provider teammates in local markets and to the UM team regarding managed care processes as well as clinical issue
Requirements for National Medical Director – UM Physician
- M.D. graduate of an accredited medical school, MBA or advanced degree in healthcare management preferred
- U.S. M.D. licensure, board certified in internal medicine, family medicine or primary care.
- 5+ years’ experience as a physician reviewer performing peer review activities.
- 2+ years managing UM team, including regional UM physicians
- Experience with the dual eligible Medicare / Medicaid population
- 3+ years post residency experience in clinical practice
- Progressive medical administration experience strongly preferred
- Proven ability in a medical leadership position in clinical credibility with experience developing and guiding team members
- A strong understanding of all aspects of managed care, including HMOs, PHOs, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, pharmacy management, and patient centered medical home concepts.
- Strong interpersonal, verbal, and written communication skills.
- The ability to navigate in a corporate matrix environment